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Case Presentation: An 8-month-old infant presented to a general emergency department with chief complaints of rhinorrhea, decreased activity, and fever. A point-of-care lung ultrasound (LUS) was performed at bedside with potential early findings of pneumonia. Based on these findings on LUS, a chest radiograph (CXR) was ordered and performed with no acute findings. He was discharged without antibiotics based on these findings; unfortunately, he returned two days later with worsening symptoms requiring chest tube placement, mechanical ventilation, and prolonged hospitalization for complicated bacterial pneumonia.Discussion: Pneumonia is a major cause of pediatric morbidity and mortality worldwide. Despite evidence supporting the utilization of LUS for the diagnosis of pediatric pneumonia, CXR remains the default imaging for clinical decision-making in most settings. In this case, earlier antibiotics and higher reliance on LUS for clinical decision-making may have prevented the morbidity associated with this hospitalization.

Case Presentation: An 8-month-old infant presented to a general emergency department with chief complaints of rhinorrhea, decreased activity, and fever. A point-of-care lung ultrasound (LUS) was performed at bedside with potential early findings of pneumonia. Based on these findings on LUS, a chest radiograph (CXR) was ordered and performed with no acute findings. He was discharged without antibiotics based on these findings; unfortunately, he returned two days later with worsening symptoms requiring chest tube placement, mechanical ventilation, and prolonged hospitalization for complicated bacterial pneumonia. Discussion: Pneumonia is a major cause of pediatric morbidity and mortality worldwide. Despite evidence supporting the utilization of LUS for the diagnosis of pediatric pneumonia, CXR remains the default imaging for clinical decision-making in most settings. In this case, earlier antibiotics and higher reliance on LUS for clinical decision-making may have prevented the morbidity associated with this hospitalization.

Background: The impact of body composition and sarcopenia in locally advanced rectal cancer (LARC) is still unclear, even several studies have been published on this issue. Our study aims to analyze the impact of sarcopenia on neoadjuvant chemoradiotherapy (nCRT) tolerance and survival outcomes. Methods: This is a retrospective, monocentric study where LARC patients treated between 2010 and 2020 were enrolled. A single slice, from the pre-therapy simulation computed tomography (CT) scan, was used to perform the body composition analysis with dedicated software. The primary endpoint was the impact of body composition on radiotherapy (RT) interruption secondarily on overall survival (OS), disease-free survival (DFS), and local control (LC). Results: The study included 628 LARC patients (40.9 % female, mean age 63.4 years): 24 % had low skeletal muscle index (SMI), 30 % had low muscle density (MD) and 17 (10.3 % of obese) were sarcopenic obese. Higher BMI (OR 2.38, 95 % CI 1.36–4.01) and lower SMI (0.73, 95 % CI 0.55–0.94) resulted as independent predictors of RT interruption. Sarcopenic obesity (HR 2.83, 95 % CI 1.24–6.45) was related to worse OS, while MD (0.96, 95 % CI 0.93–0.98), and higher SMI (0.97, 95 % CI 0.95–0.99) were related to better OS; a lower MD remained also associated even in adjusted multivariable analysis (0.96, 95 % CI0.93–0.98). Moreover, higher visceral adipose tissue (VAT) resulted associated with worse DFS (1.02, 95 % CI 1.01–1.03), while higher SMI was related to better Local Control (0.96, 95 % CI 0.93–0.99). Conclusions: Body composition analysis, particularly of muscle and fat masses, may be a useful tool for better management of LARC patients undergoing RT. Increased collaboration between radiation oncologists and clinical nutritionists is advisable, to enable early nutritional support of LARC.

Abstract Background Antimicrobial stewardship programmes are needed in long-term care facilities (LTCFs) to tackle antimicrobial resistance. We aimed to identify factors associated with antibiotic use in LTCFs. Such information would be useful to guide antimicrobial stewardship programmes. Method We conducted a systematic review of studies retrieved from PubMed, Cochrane Library, Embase, APA PsycArticles, APA PsycINFO, APA PsycTherapy, ScienceDirect and Web of Science. We included quantitative studies that investigated factors associated with antibiotic use (i.e., antibiotic prescribing by health professionals, administration by LTCF staff, or use by residents). Participants were LTCF residents, their family, and/or carers. We performed a qualitative narrative synthesis of the findings. Results Of the 7,591 screened records, we included 57 articles. Most studies used a longitudinal design (n = 34/57), investigated resident-level (n = 29/57) and/or facility-level factors (n = 32/57), and fewer prescriber-level ones (n = 8/57). Studies included two types of outcome: overall volume of antibiotic prescriptions (n = 45/57), inappropriate antibiotic prescription (n = 10/57); two included both types. Resident-level factors associated with a higher volume of antibiotic prescriptions included comorbidities (5 out of 8 studies which investigated this factor found a statistically significant association), history of infection (n = 5/6), potential signs of infection (e.g., fever, n = 4/6), positive urine culture/dipstick results (n = 3/4), indwelling urinary catheter (n = 12/14), and resident/family request for antibiotics (n = 1/1). At the facility-level, the volume of antibiotic prescriptions was positively associated with staff turnover (n = 1/1) and prevalence of after-hours medical practitioner visits (n = 1/1), and negatively associated with LTCF hiring an on-site coordinating physician (n = 1/1). At the prescriber-level, higher antibiotic prescribing was associated with high prescription rate for antibiotics in the previous year (n = 1/1). Conclusions Improving infection prevention and control, and diagnostic practices as part of antimicrobial stewardship programmes remain critical steps to reduce antibiotic prescribing in LTCFs. Once results confirmed by further studies, implementing institutional changes to limit staff turnover, ensure the presence of a professional accountable for the antimicrobial stewardship activities, and improve collaboration between LTCFs and external prescribers may contribute to reduce antibiotic prescribing.

Background: This study evaluated the effect of a multifaceted antibiotic stewardship intervention on the overall prescription of systemic antibiotics in primary care. Secondary objectives evaluated the effect on the prescription of broad-spectrum antibiotics and the seasonal variation of both total antibiotic and quinolone prescriptions, as a proxy for unnecessary prescribing. Methods: This pragmatic, randomised, controlled, before-after intervention study was conducted among general practitioners (GPs) who over prescribe antibiotics in Lorraine, France (Intervention group, n = 109; Control group, n = 236; Before period, 01/10/2017–30/09/2018; After period, 01/10/2018–30/09/2019). The intervention included a public commitment charter, a patient information leaflet and a non-prescription pad. Health Insurance data was obtained to calculate overall and broad-spectrum prescription rate (defined daily doses/1000 consultations) and the seasonal variation of prescriptions (%), by period. The intervention effect was measured with general linear mixed models including three independent variables (group, period and group x period interaction). Results: Overall, compared to the Before period, GPs in both groups prescribed significantly fewer systemic antibiotics (p

Abstract Suicide is a leading cause of death among youth, and emergency departments (EDs) play an important role in caring for youth with suicidality. Shortages in outpatient and inpatient mental and behavioral health capacity combined with a surge in ED visits for youth with suicidal ideation (SI) and self‐harm challenge many EDs in the United States. This review highlights currently identified best practices that all EDs can implement in suicide screening, assessment of youth with self‐harm and SI, care for patients awaiting inpatient psychiatric care, and discharge planning for youth determined not to require inpatient treatment. We will also highlight several controversies and challenges in implementation of these best practices in the ED. An enhanced continuum of care model recommended for youth with mental and behavioral health crises utilizes crisis lines, mobile crisis units, crisis receiving and stabilization units, and also maximizes interventions in home‐ and community‐based settings. However, while local systems work to enhance continuum capacity, EDs remain a critical part of crisis care. Currently, EDs face barriers to providing optimal treatment for youth in crisis due to inadequate resources including the ability to obtain emergent mental health consultations via on‐site professionals, telepsychiatry, and ED transfer agreements. To reduce ED utilization and better facilitate safe dispositions from EDs, the expansion of community‐ and home‐based services, pediatric‐receiving crisis stabilization units, inpatient psychiatric services, among other innovative solutions, is necessary.

Purpose: The main objective of this research was to develop a questionnaire for the subjective evaluation of the quantity and magnitude of impacts experienced by rugby players. Methods: Thirty-six male rugby union players (mean ± SD, age; 23.5 ± 3.6 years, height; 179 ± 10.0 cm, body mass; 89.58 ± 13.6 kg) participated in this study, comprising eighteen forwards and fourteen backs. Participants were tasked with completing self-reported questionnaires assessing their perception of the quantity and magnitude of impacts after thirteen consecutive matches. Objective data were concurrently collected using Micro-Electrical Mechanical Systems (MEMS) integrated with a GPS device (WIMU, Realtrack Systems, Almeria, Spain). Results: The statistical analysis revealed that 49.7% of players overestimated and 39.8% underestimated the number of impacts above 8G, with a mean team error of 0.017 impacts. Bayesian methods indicated a 95% high-density interval for the mean error between −0.46 and 0.45, with 95.8% within the region of practical equivalence, signifying negligible bias at the team level. Positional variations were notable, with Halfbacks overestimating and Fullbacks and Second Row underestimating impacts. The errors and number of impacts displayed a non-linear relationship, better described by an exponential model. Additionally, the study identified significant correlations between the number of impacts players estimated and the actual impacts received, further underlined by position-specific trends, suggesting that players’ estimation abilities are influenced by the actual exposure to impacts and their playing positions. Conclusions: The utilization of a subjective impact questionnaire is a valid tool to assess rugby players level of impacts during a match. This approach proves particularly valuable in situations where technology is unavailable, showcasing its adaptability as a practical tool in diverse sporting contexts.

Visual imagery has been proposed to be one of eight mechanisms by which music induces emotion in listeners. Initial research into aphantasia, a condition referring to individuals who do not (or only minimally) form visual imagery in their mind's eye, suggests that aphantasics may experience reduced emotional experiences in response to imagined stimuli. In this two-part online investigation, we sought to explore the emotional experiences of aphantasics within the context of music listening. In Survey 1, we compared 51 aphantasics to 51 control individuals in terms of their experiences of visual imagery, liking, and felt emotional intensity when listening to three film music excerpts. We found significant group differences in terms of visual imagery and felt emotional intensity, but not liking. In Survey 2, we examined aphantasics’ ability to recognize emotions conveyed by music, and their patterns of experience of, and engagement with, music in everyday life by comparing the responses of 29 aphantasics with 29 matched controls. We found no differences in terms of emotion discrimination ability. However, aphantasics generally experienced less Reminiscence (dimension from the Adaptive Functions of Music Listening scale) to music, as well as fewer Episodic Memories (dimension from the MecScale). Aphantasics and control listeners did not exhibit differences in terms of sensitivity to musical reward (measured using the BMRQ) or in terms of musical sophistication (measured using the Gold-MSI). Finally, our findings suggest nuanced differences between controls and those with pure and minimal aphantasia. In all, we reveal the influence that aphantasia can have on emotional responses to music and thus provide further evidence for the relationship between visual imagery and music-induced emotion.

Purpose: The main objective of this research was to develop a questionnaire for the subjective evaluation of the quantity and magnitude of impacts experienced by rugby players. Methods: Thirty-six male rugby union players (mean ± SD, age; 23.5 ± 3.6 years, height; 179 ± 10.0 cm, body mass; 89.58 ± 13.6 kg) participated in this study, comprising eighteen forwards and fourteen backs. Participants were tasked with completing self-reported questionnaires assessing their perception of the quantity and magnitude of impacts after thirteen consecutive matches. Objective data were concurrently collected using Micro-Electrical Mechanical Systems (MEMS) integrated with a GPS device (WIMU, Realtrack Systems, Almeria, Spain). Results: The statistical analysis revealed that 49.7% of players overestimated and 39.8% underestimated the number of impacts above 8G, with a mean team error of 0.017 impacts. Bayesian methods indicated a 95% high-density interval for the mean error between −0.46 and 0.45, with 95.8% within the region of practical equivalence, signifying negligible bias at the team level. Positional variations were notable, with Halfbacks overestimating and Fullbacks and Second Row underestimating impacts. The errors and number of impacts displayed a non-linear relationship, better described by an exponential model. Additionally, the study identified significant correlations between the number of impacts players estimated and the actual impacts received, further underlined by position-specific trends, suggesting that players' estimation abilities are influenced by the actual exposure to impacts and their playing positions. Conclusions: The utilization of a subjective impact questionnaire is a valid tool to assess rugby players level of impacts during a match. This approach proves particularly valuable in situations where technology is unavailable, showcasing its adaptability as a practical tool in diverse sporting contexts. [ABSTRACT FROM AUTHOR]

Aims: To assess French nursing home nurses' opinions on the potential evolution of their antibiotic stewardship role, facilitators and barriers, and nurses' characteristics associated with their opinion toward new roles regarding antibiotic prescribing. Design: We conducted a cross‐sectional study in French nursing homes with ≥20 beds and for which an email address was available in a national database managed by the French government between May and June 2022. Methods: A self‐administered internet‐based questionnaire of 43 closed‐ended Likert items was sent to directors of eligible nursing homes by email asking them to forward the link to the questionnaire to the nurses and head nurses of their institution. Data analysis included descriptive statistics and χ2 tests. Results: 7215 nursing homes were sent the online questionnaire; 1090 participants completed it partially or totally and 923 fully filled in the questionnaire. A majority of nurses supported strengthening and expanding their antibiotic stewardship role. Regarding new roles, over 70% agreed that nurses could collect urine samples to perform a urine culture on their own initiative, prescribe microbiological laboratory tests, and change the drug formulation or the administration route of the antibiotic prescribed by the general practitioner. One‐third declared that they could initiate antibiotics for some infections and/or change the empirical antibiotic treatment prescribed by the general practitioner. Nurses from public nursing homes with connection to a hospital (27.5% vs. >35% for other status) and with recent experience in nursing homes (31% for <5 years of practice vs. 41% for 10 years or more) were less likely to agree to prescribe antibiotics. Conclusions: This quantitative questionnaire survey identified potential new nurses' roles in antibiotic stewardship that seem to be acceptable and feasible for participants. These new nurses' roles need to be explored in future experimentations before considering implementation. Reporting Method: The study adhered to relevant EQUATOR guidelines and followed the STROBE reporting guidelines. Patient or Public Contribution: A self‐administered internet‐based questionnaire was sent to directors of eligible nursing homes by email asking them to forward the link to the questionnaire to the nurses and head nurses of their institution. Nurses and head nurses who were interested and willing could complete the questionnaire online partially or fully. Trial and Protocol Registration: This study is not a clinical trial and is not eligible for trial registration. We used another suitable study registration site, the Center for Open Science. [ABSTRACT FROM AUTHOR]

This paper proposes a new time scaled Wiener process with random effects that has been specially designed to allow the description of non‐monotonic degradation phenomena with bathtub shaped degradation rate, here intended as derivative of the mean function. Two different parameterizations of the proposed Wiener process are suggested, and the main features of the process are illustrated and discussed. The maximum likelihood estimation of its parameters is addressed. A failure threshold model is adopted to formulate and estimate the probability distribution function of the remaining useful life, which constitutes the core prognostic tool in condition‐based maintenance. As a motivating example, the proposed model is applied to a set of real degradation data of metal‐oxide‐semiconductor field‐effect transistors, where, as a result of preliminary analyses, some of the process parameters are assumed to be random in order to describe the considerable heterogeneity observed between the degradation paths of different units. Obtained results demonstrate the affordability and utility of the proposed model, especially for the estimation of unit‐specific features performed on the basis of degradation data collected in the early phase of the life of a unit belonging to the considered heterogeneous population. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial stewardship programmes are needed in long-term care facilities (LTCFs) to tackle antimicrobial resistance. We aimed to identify factors associated with antibiotic use in LTCFs. Such information would be useful to guide antimicrobial stewardship programmes. Method: We conducted a systematic review of studies retrieved from PubMed, Cochrane Library, Embase, APA PsycArticles, APA PsycINFO, APA PsycTherapy, ScienceDirect and Web of Science. We included quantitative studies that investigated factors associated with antibiotic use (i.e., antibiotic prescribing by health professionals, administration by LTCF staff, or use by residents). Participants were LTCF residents, their family, and/or carers. We performed a qualitative narrative synthesis of the findings. Results: Of the 7,591 screened records, we included 57 articles. Most studies used a longitudinal design (n = 34/57), investigated resident-level (n = 29/57) and/or facility-level factors (n = 32/57), and fewer prescriber-level ones (n = 8/57). Studies included two types of outcome: overall volume of antibiotic prescriptions (n = 45/57), inappropriate antibiotic prescription (n = 10/57); two included both types. Resident-level factors associated with a higher volume of antibiotic prescriptions included comorbidities (5 out of 8 studies which investigated this factor found a statistically significant association), history of infection (n = 5/6), potential signs of infection (e.g., fever, n = 4/6), positive urine culture/dipstick results (n = 3/4), indwelling urinary catheter (n = 12/14), and resident/family request for antibiotics (n = 1/1). At the facility-level, the volume of antibiotic prescriptions was positively associated with staff turnover (n = 1/1) and prevalence of after-hours medical practitioner visits (n = 1/1), and negatively associated with LTCF hiring an on-site coordinating physician (n = 1/1). At the prescriber-level, higher antibiotic prescribing was associated with high prescription rate for antibiotics in the previous year (n = 1/1). Conclusions: Improving infection prevention and control, and diagnostic practices as part of antimicrobial stewardship programmes remain critical steps to reduce antibiotic prescribing in LTCFs. Once results confirmed by further studies, implementing institutional changes to limit staff turnover, ensure the presence of a professional accountable for the antimicrobial stewardship activities, and improve collaboration between LTCFs and external prescribers may contribute to reduce antibiotic prescribing. [ABSTRACT FROM AUTHOR]

The article describes the experiences of firearm-injured children and their families. It describes a 12-year-old male who experienced gunshot in his neck. Also mentioned are recommended actions and anticipated outcomes to address childhood firearm injury, coalition building to identify and address research gap in knowledge of mental health service use after firearm injuries, and recommended approach to pediatric nonfatal firearm injuries rooted in health equity.

The article titled "Discussion of 'Specifying prior distributions in reliability applications'" provides a comprehensive review of Bayesian inferential procedures for analyzing censored data in reliability applications. It discusses different types of censoring and provides guidance on setting prior distributions for commonly used distributions. The article also explores noninformative and weakly informative prior distributions and their combinations for model selection using the Bayes factor. The text discusses the mathematical formula for calculating the probability of observed data under a specific model and the concept of marginal probability. It emphasizes the importance of proper prior distributions and provides guidance on their formulation. No datasets were generated or analyzed in this study. [Extracted from the article]

The article evaluates a statewide initiative in rural emergency departments (EDs) aimed at addressing the increasing presentation of children with mental health concerns and subsequent ED boarding. The initiative involves providing youth activity kits and self-care binders to ED staff caring for children boarding with primary mental health issues, with the assessment focusing on utilization and acceptability through a survey of clinical quality leaders in participating EDs (92% response rate).